All Eyes on the House: Will The Fox Be Guarding the Hen House?
As everyone waits for the House to take action on the cost control bill, a WBUR story yesterday brought good news and bad news. The good news is that the House will likely take action on the bill shortly; the bad news is that the pharma gift ban may be absent from the bill that comes out of the House. Will the House cave to industry pressure and leave out this critical provision put forth by the Senate President? We sure hope not.
The evidence is clear – in order to effectively control costs, we must ban pharmaceutical gifts to prescribers. Countless studies have found that gifts of all sizes inherently impact prescribing decisions leading to unnecessary prescribing of the most expensive and least tested drugs and, in turn, higher health care costs and lower quality of care. Banning pharmaceutical gifts to physicians isn’t a silver bullet to our cost control problem, but it is a piece of the solution.
The evidence also shows that we can not rely on the industry to self regulate. Mandatory disclosures of gifts made in other states show that since the release of an industry internal code of conduct (“the PhRMA Code”) in 2002, pharmaceutical industry gifts and payments to physicians did not decline, but instead increased. In fact, in response to questions by Senator Moore at the legislative hearing on the cost control bill, PhRMA was not able to point to a single example of a violator of the industry standards being sanctioned.
This data is corroborated by Shahram Ahari, former Eli Lilly sales representative. According to Ahari, it is common for sales representatives to give gifts in violation of the Code. The problem goes deeper than lack of enforcement, though. Even if the standards were adequately enforced, they’re not sufficiently strong. The PhRMA Code, which sets the industry standards, allows gifts of up to $100 and meals. The result of the weak standards and weak enforcement is continued offering of inappropriate gifts to our health care providers. According to Ahari, pharmaceutical sales reps continue to give gifts including bottles of alcohol, tickets to entertainment events, electronics and even gym memberships.
The industry has been left to self-regulate for years and the result has been inappropriate gifts and payments, undue influence, higher costs and compromised quality of care. The House must follow the Senate’s lead and seize the opportunity to institute a much needed statewide ban on pharmaceutical gifts. If they fail to do so they will be leaving the fox to guard the hen house.
Lisa Kaplan Howe
July 8th, 2008 at 2:41 pm
[...] Our Fellow coalitioneers over at Health Care for All have a good post on the Massachusetts pharma gift ban as we await word on whether House lawmakers will include the section in its recommended version of the health care cost containment bill being finalized now. Check it out here. [...]
July 8th, 2008 at 3:10 pm
Dear Ms. Howe,
While we all agree that health care costs need to be controlled, there is an apparent and obvious witch hunt directed towards the lowest rung on the proverbial totem pole - the promotional products industry. Promotional giveaways to doctors account for less than 10% of the overall marketing and advertising budgets of drug companies. Yet, the promotional products industry is regrettably the recipient of 90% of the grief and ridicule and is the fall guy for today’s high health care costs. What about the plethora of drug ads on all major television networks? have you ever watched the nightly network news programs? Drug commercials are all that are shown! What about the countless full page ads in every well known magazine that promotes prescription drug brands? Where is the legislative pressure to curtail these “excessive” spending practices of drug companies?
My company produces medically relevant hand care products for drug company promotions. Our bottles of liquid hand soaps and antiseptic hand rinses are of obvious benefit to the patient and the practice of medicine. PromoSoap pioneered this successful product line since the early 90’s. This has become our major source of revenue. A full and complete ban of all promotional products will put dozens of my employees on the unemployment line. Is this the unintended result of a no-compromise,unforgiving, total ban of promo products?
The day that our politicians stop using promotional products to promote their own election chances is the day drug companies should stop using promotional items as gentle brand reminders as well. Until then - stop whipping the promotional products industry as the bad guys.
Tighten things up. I’m all for it. But let’s be realistic. Common sense and logic should reign. Is there really a benefit to outlawing a private labeled bottle of hand soap intended for medical use? I think not.
July 8th, 2008 at 5:11 pm
Mr. Butler,
In no way is the gift ban intended to target the promotional products industry. This is a matter of improving patient care and controlling costs, plain and simple.
Gifts of all sizes impact prescribing decisions and patients suffer as a result. Numerous studies have found that even promotional products impact prescribing decisions. They serve as a reminder, or constant commercial (far from gentle), in the provider’s line of sight day after day, driving up name recognition. The continuous provision of these gifts also creates a friendship and sense of reciprocity. Doctors are not immune to this subtle influence as they themselves recognize. A survey published in the American Journal of Medicine found that 84% of doctors recognize the influence of gifts. As does the pharmaceutical industry. They give these gifts, not out of charity, but because they increase their bottom line. If they weren’t influential, they wouldn’t be given.
Nobody wants to see doctors going without hand soap. However, providers can and should purchase these items themselves. There is no need for them to come from the pharmaceutical industry or include ads.
Certainly the prevalence of direct-to-consumer ads is also concerning and must be addressed. Unfortunately, that is not a problem our state leaders can take action on. It must be addressed on the federal level. However, direct-to-consumer marketing and gifts to physicians go hand-in-hand. Drug companies coordinate the two types of advertising to make sure that providers are “cued” up to prescribe the drugs their patients are requesting.
We do not want to see the promotional products industry suffer and I hope you will be able to supplement any loss you face by working with other industries. However, the state must take action to protect patient care and to preserve access to health care.
July 10th, 2008 at 10:10 pm
This is bunk. I prescribe medicine based on the best information available to me fromevery source I can tap. I listen to both sides argue about controls on gifts to prescribers but never the buying and selling of politicians. Our practice gives the pens and pads to churches, samples go to patients who cannot afford their meds (buy a month, get a month free) and who are desperate to pay for their $4 prescriptions and their $4 gasoline. Why not just eliminate the business tax break on sales and promotion as business costs and let pharma decide how it spends its money. Pharma companies are designed to make profits. Oil companies are making obscene profits but no one would think of telling them how to spend their profits. How about some rational healthcare policy? Last I looked I was in the private practice of medicine. If you want to tell me when and how I practice and pay me for the care I deliver I will listen to you. As of now, I give away my time to treat the indigent and government won’t even provide medications to my uninsured and underinsured patients. Yet your first targets are pens and paper? Get real!
July 15th, 2008 at 11:05 pm
[...] under their own codes of ethics. We previously commented on the inadequacies of this approach (blog: Will the Fox Be Guarding the Hen House?), and hope the House can strengthen the language on the [...]
July 21st, 2008 at 6:16 pm
[...] The House also rejected an amendment to strengthen the provision addressing pharmaceutical gifts to health care providers. Representative Malia provided amazing leadership and wonderful words on this priority of HCFA and the MA Prescription Reform coalition, as did co-sponsors of the bill, including: Representatives Callahan, D’Amico, Eldridge, Kocot, Provost, Smizik and Story. Though the House acknowledged the conflict of interest created by gifts, they opted to rely on industry to self-regulate and self-police their gift-giving practices, a tactic that has proven for years to be inadequate in addressing this driver of costs and threat to patient safety (see blog: Will the Fox Be Guarding the Hen House?). [...]